A very brief summary:
HITECH Act’s Impact in 3 Simple Phrases | EMR (EHR) and HIPAA.
What was summarized (from Vince Kuraitis, who I know slightly and shares my generally pragmatic attitude):
Feline Foot-Dragging: Three Non-Innovative Aspects of HITECH
Vince’s post is particularly blogosphere-appropriate because it includes numerous humorous photographs of cats.
And finally, some additional thoughts on HITECH and open source EMRs:
HITECH Basically Excludes Open Source EHR If They Select CCHIT
89% of diabetics search for health information on the Internet, and 66% of them search for pharmaceutical information, according to Manhattan Research. Message boards, blogs, and social network web sites are popular places to post health data. Health 2.0 tools, however, are only used by 31% of the patient population. In absolute numbers, that’s still a lot.
I may try to dig up some time series data on this (this is apparently the eighth iteration of the survey).
There is no excuse for the physician appointment scheduling process to be anywhere near as cumbersome as it is. I just read about a company that makes a pretty sophisticated, embedded appointment scheduler. There are a few dozen other companies doing the same thing.
I don’t really expect small physician offices to start adopting this technology. Integration with existing practice management and patient scheduling systems is probably too challenging. I’d also expect to hear arguments about triage, although every time I’ve ever called a physician’s office to make an appointment it’s been a purely clerical activity.
What I do expect is for online appointments to become pretty prevalent for every other business – ramping up the pressure on healthcare providers that much more.
Setster: Let Your Clients Pick Their Own Appointment Times – ReadWriteWeb.
On Monday, IBM is going to release the “Open Cloud Manifesto,” which will promote interoperability principles for applications running across different cloud platforms. Amazon, Google and SalesForce won’t be playing, and apparently weren’t invited to the table either.
I find this whole cloud thing a little weird. For one thing, the definition is even muddier than the usual IT buzzwords (as discussed in a Page 1 WSJ article last week). Personally, I tend to think of cloud computing as the ability to run your own applications on infrastructure that belongs to somebody else, essentially replacing parts of an internal corporate data center. I use an older buzzword — Application Service Provider – to talk about services like GMail and Salesforce.com. Things make more sense that way — infrastructure and applications are not the same thing.
I’ve been thinking a lot recently about the economics of cloud computing, both for applications and infrastructure (and where the trade-offs are). One thing is obvious — open standards for infrastructure on the cloud would be huge, particularly for smaller organizations (like us) who might want to run their entire infrastructure somewhere other than their own office. We’ve been starting to use Amazon’s EC2 environment to set up servers for our own development work. Talking with corporate developers, some have found that it’s easier to set up servers in Amazon for quick development and testing than to work with their own IT departments to do the same thing. This is really important for burst requirements — when we need 20 client systems to load test an application running on a single server, we can have them, and it costs $15 to run the test. Before the cloud — well, that test probably just wouldn’t have gotten done.
In the application space, we recently retired an “enterprise wiki” product in favor of an account on pbWiki. It’s more reliable, and at $8 per user per month turns out to be more cost effective than hosting a wiki on one of our own servers. Installing open source software on an Amazon EC2 instance (which is about as cheap as you can get) would have cost us $75 a month in hosting fees, plus all the hassle of keeping the software up and running. At some point those numbers will flip – for a ten person team, a $25/server/month cloud pricing might justify the up-front cost of installing our own wiki server, particularly if we can load some other things on as well and if the software itself doesn’t require much care and feeding.
IBM’s manifesto is interesting because it may lead to lower prices for hosting in the cloud, or at least lower switching costs when moving from one cloud provider to another (lower overall prices should follow naturally from increased competition). The secondary software market has already begun to fill in some of the portability gaps, and right now I’m looking at a few products that try to make management of cloud resources a little more generic across providers. Some of them are quite impressive — if they get a little better, they may take the “open cloud” right out of the service providers’ hands.
I’m not attending the HIMSS show in Chicago this year. Since I’m currently neither buying nor selling hospital information systems, there’s wasn’t enough to justify the trip. But if I were going, I’d show up to the CCHIT leadership meeting with open source advocates.
Here’s the challenge: it’s hard to take an open source software package and run it through an expensive certification process. When the Certification Commission for Health IT was originally proposed, the idea was to provide physicians with an extra level of confidence in their prospective EHR purchases. From what I’ve been able to tell, the impact in this respect has been pretty modest – not least because virtually every major vendor spent the money and got the certification.
The American Recovery and Reinvestment Act Health IT provisions (including $17 billion in funding for EHR use) may change the equation. The law requires “meaningful use” of EHRs to qualify for money, and that’s generally been taken as meaning certification. It’s not clear that CCHIT, as an organization, is going to be the organization that provides that certification. But, realistically, there isn’t anybody else out there who can do it. And there’s an appropriateness issue that has not been entirely settled. In technology, certification works best when there’s something concrete to certify. Interoperability certifications, for instance, make a lot of sense, and they’re quite common in the network infrastructure world. Still, despite excellent work that’s been done on standards, it’s still early days.
To my mind, this leaves the government with two options. One is to embrace CCHIT certification as the marker for “meaningful” EHR use. The other is to set a much lower bar – possibly a simple checklist, including features like support for the main electronic prescribing transactions. It’s easy paperwork, and it wouldn’t be hard for the government to audit. Providers using any CCHIT certified system can automatically be covered, but the ARRA threshold can be set lower.
More (from the FOSS side) from Fred Trotter, here. Includes the excellent line “like offering to meet with the Rebel Alliance at the annual Death Star conference.” And I thought HIMSS was supposed to be a boat show!
I wrote a blog for two years. It was called “The Integrative Stream”, and it ran to 170 posts, some of which were marginally interesting. That blog stopped in 2006 for a very simple reason – I moved down to DC to spend a year working for the US government, as a member of the policy staff at the Centers for Medicare and Medicaid Services. Working for the government is an interesting experience, but it has a couple of drawbacks. One is that you’re not supposed to publish anything related to your area of responsibility without going through many, many layers of approval. My blog, which focused on the healthcare and software businesses, certainly fell into that category.
So now it’s 2009. After my year in government I moved back to Boston, and started working on a project to build a “Translational Informatics” group at the Children’s Hospital Informatics Program. Starting with projects in the Personally Controlled Health Record area, we built up a great team, and developed some interesting new technologies and processes for doing software development, better, in healthcare. It’s a great team, and when I started thinking about doing a blog again, I decided to invite them all to join me.
So we’ve got quite a group: a software architect turned MBA healthcare policy wonk, a couple of computer scientists, a user interaction designer, and a doctor. They’ll introduce themselves over the next week or so, and this blog is going to cover quite a few areas. At one end of the spectrum, we’ll look at companies and business models in the Health IT space and policy issues for promoting the use of technology in healthcare. But we like to do things on the ground, so we’ll be covering a lot of brass tacks topics too. So expect to see Java code, thoughts on the software development process, and explorations of user-centric, goal-oriented design as applied to healthcare software. There may also be recipes.
Should you read it? Yes. Obviously, the healthcare policy audience may not be interested in software development processes or neat Java tricks, so we’ve organized the blog into categories that should make it an easier read. If you have any suggestions or comments, you can reach us at info (AT) rmatics.org.